In the Matter of the Civil Commitment of: Chaleunsouk Keomany.

In the Matter of the Civil Commitment of: Chaleunsouk Keomany. A07-521, Court of Appeals Unpublished, August 21, 2007.

This opinion will be unpublished and

may not be cited except as provided by

Minn. Stat. § 480 A. 08, subd. 3 (2006).

 

 

STATE OF MINNESOTA

IN COURT OF APPEALS

A07-521

 

 

In the Matter of the Civil Commitment of:

Chaleunsouk Keomany.

 

 

Filed August 21, 2007

Affirmed Willis, Judge

 

Hennepin County District Court

File No. 27-MH-PR-06-657

 

 

Michael C. Hager, 301 Fourth Avenue South, Suite 270, Minneapolis, MN 55415 (for appellant Chaleunsouk Keomany)

 

Mike Freeman, Hennepin County Attorney, John L. Kirwin, Assistant County Attorney, C-2000 Government Center, Minneapolis, MN 55487 (for respondent State of Minnesota)

 

            Considered and decided by Willis, Presiding Judge; Toussaint, Chief Judge; and Randall, Judge.

U N P U B L I S H E D   O P I N I O N

WILLIS, Judge

Appellant challenges his indeterminate commitment as mentally ill and dangerous, arguing that (1) he did not meet the "overt act" requirement when he assaulted his mother with a wooden dowel because the wound inflicted was not serious and he showed extreme remorse; (2) the likelihood of future serious physical harm to another was not shown; and (3) indeterminate commitment was not warranted because his condition improved substantially since the initial-commitment hearing.  Because clear and convincing evidence supports the conclusion that the statutory standards for initial and indeterminate commitment were met, we affirm. 

FACTS

            Appellant Chaleunsouk Keomany was first hospitalized in July 2004 after he reported symptoms of insomnia, behavioral changes, delusions, and auditory hallucinations.  He was diagnosed with psychosis and directed to continue medication as an outpatient.  Three weeks later, Keomany was rehospitalized after he stopped taking his prescribed antipsychotic medication.  He showed symptoms of paranoia, stating that he believed that his family intended to harm him.  He held a knife to his mother's neck and threatened other family members with a knife.   

            In September 2004, the district court committed Keomany for a period of six months. The district court also issued a Jarvis order authorizing Keomany's involuntary treatment with neuroleptic medication.  Keomany remained hospitalized until the end of October 2004, when he was released to a group home.  His discharge diagnosis was paranoid schizophrenia.   

            Keomany began outpatient treatment in December 2004.   In March 2005, soon after his commitment expired, Keomany reported to a nurse that he had decreased his medication on his own, and he asked to be taken off medication.  The nurse encouraged him to discuss medication issues with his doctor. 

            Keomany did not attend his next doctor's appointment or take his prescribed medications until December 2005, when he reentered the hospital for two weeks after experiencing auditory hallucinations.  While Keomany was hospitalized, he took his medications but refused to participate in therapy groups and was once "secluded" from the other patients after he became aggressive.  He was discharged to his family.

            On December 21, 2005, the district court found that Keomany was mentally ill with paranoid schizophrenia and issued another six-month commitment order, which was stayed on the conditions that Keomany complete hospital treatment, follow all directions of the treating doctor, take all prescribed medications, and cooperate with aftercare.  Keomany initially met the conditions of the stay, and his treatment changed from injected to oral medication.  But a June 2006 hospital report states that for "several months" Keomany had not taken his prescribed medication as an outpatient or seen his psychiatrist.  

            On June 27, 2006, six days after Keomany's commitment expired, police were called to the family home after Keomany hit his mother on the head with a two-pound wooden dowel, a kitchen utensil.  This assault produced lacerations to his mother's scalp that required 15 stitches and several days' hospitalization.  Keomany also held a knife to his own abdomen, but he threw the knife away when police arrived.  Keomany told investigating police officers that "there were ghosts in the house [who] told him that his mother . . . was not who she said she was and that he needed to assault her."

            Keomany was hospitalized on a 72-hour hold and charged with third-degree assault.  A hospital psychologist reported that Keomany lacked insight into his psychiatric condition.  Keomany told hospital physicians that he did not remember hitting his mother. 

            On June 30, the state filed a civil petition to commit Keomany as mentally ill and dangerous.  An examining physician filed another request to administer neuroleptic medication to Keomany without his consent.  The district court appointed Nadia Donchenko, a psychologist, as a court examiner; Keomany selected Paul Reitman, another psychologist, as a second examiner.

            The district court held a combined commitment trial and Jarvis hearing.  Both court-appointed examiners; Keomany's treating psychiatrist, Dr. John Vuchetich; and several police officers testified.  All three medical experts recommended that Keomany be committed as mentally ill and dangerous.  On August 23, 2006, the district court issued its initial order committing Keomany as mentally ill and dangerous, along with another order authorizing involuntary treatment with neuroleptic medication. 

            In October 2006, the Minnesota State Security Hospital at St. Peter filed its required treatment report with the court.  The district court appointed Dr. Thomas Alberg, a psychologist selected by Keomany, as an additional examiner.  In January 2007, the district court held a review hearing.  Keomany testified on his own behalf.  Dr. Alberg testified that he believed that Keomany remained mentally ill and dangerous.  On January 11, 2007, the district court issued its order committing Keomany indeterminately as mentally ill and dangerous.  Keomany appeals from the indeterminate-commitment order.

D E C I S I O N

I.

 

            The district court may order involuntary commitment if it determines that a person is mentally ill and dangerous.  Minn. Stat. §  253B.18, subd. 1 (2006).  To order civil commitment on this basis, the district court must find that the person is mentally ill and that as a result of that mental illness, the person presents a clear danger to the safety of others, as demonstrated by an "overt act causing or attempting to cause serious physical harm to another."  Minn. Stat. § 253B.02, subd. 17 (2006).  The district court must also determine that there is "a substantial likelihood that the person will engage in acts capable of inflicting serious physical harm on another."  Id.

            On review, this court is limited to examining whether the district court complied with the requirements of the commitment statute and whether the commitment is justified by findings based on evidence received at the hearing.  In re Knops, 536 N.W.2d 616, 620 (Minn. 1995).  This court reviews the record in the light most favorable to the district court's decision, and the district court's factual findings will not be set aside unless they are clearly erroneous.  Id.  This court reviews de novo the legal question of whether clear and convincing evidence supports the conclusion that an appellant meets the standards for commitment.  Id. 

            After the district court makes an initial commitment of a person as mentally ill and dangerous, a second hearing is required to review the written treatment report of the treatment facility.  Minn. Stat. § 253B.18, subd. 2 (2006).  If the district court then finds that the patient continues to be mentally ill and dangerous, it must order commitment for an indeterminate period.  Id., subd. 3 (2006). 

            As a preliminary matter, Keomany did not appeal from the initial-commitment order but only from the order for his indeterminate commitment.  The state argues that, therefore, Keomany's challenge to his initial commitment is not properly before this court.   See Minn. R. Civ. App. P. 103.04 (stating that appellate court "may reverse, affirm or modify the judgment or order appealed from") (emphasis added).  But this court may, on appeal, "review any order affecting the order from which the appeal is taken."  Id.  Because the district court's initial-commitment order affected the later indeterminate-commitment order, we will consider Keomany's challenges to both orders.  See In re Abrahams, 394 N.W.2d 234, 237 n.1 (Minn. App. 1986) (reviewing a commitment order that was not appealed from on the ground that the order affected a later, appealed-from order on the duration of the commitment). 

            Keomany does not dispute that he is mentally ill.  But he contends that the record does not permit a finding that he presents a clear danger to the safety of others because the assault on his mother was not sufficiently serious enough to satisfy the statutory requirement of serious physical harm.  The issue of whether a person committed an act "causing or attempting to cause serious physical harm to another" presents a legal question, which this court reviews de novo.  See In re Kottke, 433 N.W.2d 881, 884 (Minn. 1988). 

            In Kottke, the Minnesota Supreme Court concluded that the acts of a mentally ill man in striking two security guards, who easily subdued him, were insufficient to show that the man inflicted or intended to inflict serious physical harm.  Id. at 882, 884.  But Keomany assaulted his elderly mother with a two-pound wooden dowel, producing a head injury that required 15 stitches and hospitalization.  Therefore, the record sufficiently supports the district court's finding that Keomany "engaged in an overt act causing or attempting to cause serious physical harm" to his mother so as to satisfy that statutory requirement.  See Minn. Stat. § 253B.02, subd. 17.

            Keomany also argues that the record fails to support the determination that he would be likely to commit future acts capable of inflicting serious physical harm.   The district court found that "[t]here is a substantial likelihood that [Keomany] will engage in acts capable of inflicting serious physical harm" because Keomany "is medication-noncompliant and has demonstrated no insight into his assaultive behavior." 

            Keomany argues that the experts failed to make a statistical estimate of the likelihood that Keomany would inflict future serious physical harm and that in assessing future risk, they used only a hypothetical that assumed that Keomany would not be successfully treated.  But Keomany does not challenge the district court's finding, based on expert testimony, that he has been medication-noncompliant in the past.  When factual findings rest almost entirely on expert testimony, the district court's evaluation of credibility is particularly significant.  In re Joelson, 385 N.W.2d 810, 811 (Minn. 1986).  Both Dr. Vuchetich and Dr. Donchenko testified that Keomany believed that his medication was contributing to his violent-behavior problems and that he would only take the medication when it was administered in a supervised setting.  

            In addition, Drs. Reitman, Vuchetich, and Donchenko all testified that Keomany lacked insight into his mental illness.  Keomany argues that this lack of insight reflects a stigma associated with mental illness in his Laotian culture.  But the record shows that Keomany's family members, who are from the same culture, have accepted the fact of his mental illness.  Finally, Keomany's treating psychiatrist, Dr. Vuchetich, testified that he had a "real concern" about Keomany's escalating behavior of violence against family members.  See In re Welfare of Hofmaster, 434 N.W.2d 279, 282 (Minn. App. 1989) (stating that the seriousness of past acts may be considered in determining whether the record supports a determination that a person is presently a danger to others). 

            Because the evidence supports the district court's findings and the findings support the conclusion that Keomany meets the statutory definition of a person who is mentally ill and dangerous, the district court did not err by granting the petition for Keomany's initial commitment. 

II.

            Keomany argues that the need for his indeterminate commitment was not proved by clear and convincing evidence.  The proponent of indeterminate commitment has the burden to establish by clear and convincing evidence that the statutory requirements for commitment continue to be met.  In re Verhelst, 350 N.W.2d 494, 495 (Minn. App. 1984).   

            Based on evidence at the review hearing, the district court found that since Keomany's initial commitment, "[n]othing significant about [his] illness has changed."  The record supports this finding.  The treatment report filed by the Minnesota State Security Hospital indicates that Keomany had been responding favorably to treatment with antipsychotic medications after receiving those medications under the Jarvis order.  But the report also states that Keomany continued to lack insight into his mental illness and had a pattern of failing to participate in treatment.  The report predicts that if Keomany were to return to the community and be expected to continue voluntary compliance with treatment, he would eventually discontinue his medication, and it was likely that he would "experience a resurgence of the symptoms of psychosis that he has previously demonstrated . . . [that] have led him to act out in a threatening or violent manner."  See In re Malm, 375 N.W.2d 888, 891 (Minn. App. 1985) (affirming district court's determination that a symptom-free patient continued to be mentally ill and dangerous based on precommitment behavior indicating that he is dangerous and that, if released, he would stop taking medication and symptoms would recur). 

            Keomany argues that his continuing lack of insight into his mental illness was not demonstrated by clear and convincing evidence.  He testified at the review hearing that he "ha[s] to accept" that he has a mental illness; that he has been taking his prescribed medication; and that, at one time, he requested electroconvulsive therapy.  But he also testified that he "[did not] think" he needed medication to control his condition.  Dr. Alberg, Keomany's expert psychologist, testified that, although Keomany acknowledged his diagnosis of a mental illness, Keomany does not understand what the symptoms of the illness are and does not agree with the diagnosis.  Dr. Alberg testified that, in his opinion, Keomany remains mentally ill and dangerous.  Because clear and convincing evidence supports the conclusion that Keomany continues to meet the standards for commitment as mentally ill and dangerous, the district court did not err by continuing Keomany's commitment indeterminately. 

            Affirmed.